Many hospitals today have a hospital information system (HIS), although the quality and sophistication of the HIS systems vary dramatically. The HIS typically is the backbone of the hospital computer network and contains the basic information for all of the hospital's patient records, billing, ordering and other business information.
The medical records of a patient in a hospital typically contain laboratory and test data, physicians orders and other information which is important to the treatment of the patient and which is also typically not available on the HIS. Additionally, with the increase in insurance and other third party payment plans, it is important for a hospital to accurately bill for the services and treatment provided as well as to monitor their costs of providing the treatment and services. In many hospitals which provide the full range of cardiac services, the hospital may receive between 25 and 35 percent of their revenues from cardiology patients. This category of patients also has one of the highest needs for rapid and complete access to their medical records.
In about 1976, the Marquette Electronics Company introduced a computerized electrocardiography management system. This system provided data storage, viewing, retrieval and report generation capabilities for diagnostic 12 lead electrocardiographs acquired from Marquette equipment. This type of system is known as a closed system because it communicates only with electrocardiography equipment purchased from the manufacturer of the management system. Therefore, once a hospital purchases a closed management system, all future pieces of medical equipment must be purchased from the same manufacturer in order to communicate with the management system. With the increased concerns about the increasing costs of healthcare, it is increasingly important that each piece of equipment purchased by a hospital or clinic communicate with existing equipment and perform as many functions as possible.
ECG management systems are a vital component of the computerized ECG equipment market. These systems expedite the flow of ECG reports in a hospital by improving the access to records for copies and serial comparison analysis. The computer also assists with the information routing tasks such as editing, sorting, tracking and printing of the ECG records. Many of the functions of a cardiology department are significantly improved by the increased access to the ECG information. The staffing required to process ECGs may be reduced with the addition of an ECG management system.
The cardiology diagnostic department of a hospital uses an ECG management system extensively. One part of an ECG management system is typically a computer based ECG interpretation program. Although this program is not as skilled as a cardiologist, the program often provides a useful initial review from which the cardiologist may make further revisions and provide the final diagnosis.
Additionally, the computer program adds the ECG measurements and interpretation in a text format that may be edited by the clerical staff. This improves the accuracy, throughput and efficiency of the entire department in maintaining the medical records of a patient. Additionally, both adult and pediatric ECG records are typically managed and stored by the ECG management system for use in follow-up or subsequent visits of the patient.
Some of the basic functions of the current ECG management systems are data storage, data retrieval, data viewing and the streamlining of the overread process. In the prior practice which used paper copies of the ECG of a patient's records or with an ECG management system, an unconfirmed report of the ECG test is provided to the central station for later overreading or review by a cardiologist. A second copy of the unconfirmed report is typically left in the patient's record at the nurse's station. At some point, the physician on duty will pick up the ECG tracings from the central station and overread or edit them as time permits. The annotated reports are then returned to the central station for editing and data entry. Once the edited record is entered, the confirmed report is then printed and dispatched to the nurse's station to replace the unconfirmed report in the patient's record. It is extremely important that the patient's records not be lost or delayed. The major advantage of the ECG management system is that the transfer to the patient's primary record is instantaneous once it has been entered and there is no likelihood that the confirmed report will be lost or delayed in the hospital delivery system. Additionally, there is less opportunity for data entry errors because it is no longer necessary to clerically enter the physician's comments or diagnosis.
A further advantage of the ECG management system is that a hospital administrator may request a status report from an ECG management system to determine how many ECGs are at the various stages of being overread. In larger hospitals, this allows the administrator to monitor the need for data entry personnel or to monitor the efficiency of various other medical personnel.
Additionally, smaller hospitals, clinics or cardiology offices may contract with outside services for data storage and/or overread services. The ECG management system provides the smaller facility with the benefit of an ECG management system without the additional investment or additional staff. The administrator of the facility may also obtain traffic and management information to help their facility to be more cost effective and efficient.
The currently available ECG management systems have only touched the surface of potential applications for a cardiology information system (CIS). This inability to reach their full potential has resulted primarily from the use of closed systems which limit their own usefulness to the breadth of the product line offered by their manufacturer. As a result of the existence of "closed" systems, a number of software development companies have begun selling "translation boxes" to hospitals to enable the various acquisition devices to communicate with the pre-existing hospital systems.
It is an axiom of a hospital that the most vital record is the hardest to access and the most likely to be lost. Whether the record is an ECG or an x-ray film, the more handling it receives, the more likely it is to be lost or damaged. The ECG management system can easily produce high quality duplicate master records which may be printed or transmitted to other sites for review, editing, printing or storage. With remote transmission capabilities, hospitals may efficiently offer ECG management services or support to satellite facilities.
In addition to the record management benefits described above, a cardiology patient typically has other procedures and records which must be managed and archived. For example, the cardiology patient may have HOLTER records, stress test records, catheterization laboratory records, echocardiographic records, electrophysiology, telemetry, metabolic testing records or pacemaker follow-up test records. At present, only a few of these records are accessible to a hospital through the current ECG management system.
Therefore, there is a need for a cardiology information system which provides individual and integrated procedure reports that incorporate key clinical data from all available procedures to reliably and accurately provide proper clinical decision making and accurate reimbursement.
Additionally, there is a need for a cardiology system that provides a simple graphic user interface and standard PC hardware which also uses other standard PC software for word processing, spreadsheet and desktop publishing applications.
There is yet another need is for a cardiology information system which provides a standardized hospital information system connection so that common patient census data, billing capture, results reporting and order driven systems may be used throughout the hospital.
There is a further need for a cardiology information system which provides a standardized communication protocol so that common patient data, billing information, procedure results and medical records information may be acquired by nearly any currently available data acquisition device which may then be reviewed throughout the hospital.